Young pitchers who throw breaking balls can face serious arm problems

At the age of 12, Coney-Tyler was one of the hottest pitchers in the ranks of Walnut Creek Little League in California.

He had everything you need to be a successful young pitcher: good velocity on his fastball, the ability to change speeds and a knack for locating his pitches.

Then something happened that very nearly ended his nascent pitching career: he learned how to throw a slider.

"It definitely wreaked havoc on his arm," said Coney-Tyler's father, Tim Tyler. "Prior to that he was just throwing a fastball and a changeup, and he'd had no problems. I attribute his troubles to the slider."

Tim Tyler, a longtime coach in Walnut Creek Little League, said Matt was diagnosed by an orthopedist as having suffered a severely strained biceps and what could only be characterized as a "sore elbow." When Tyler questioned the possible source of such an injury, the doctor said that it almost certainly could be attributed to the new pitch.

Matt, now 17, will be a senior at Las Lomas High School in the fall. He is a catcher and relief pitcher on the Knights' varsity squad. He, too, is convinced that the combination of the slider and his playing catcher -- another position that allows no rest for the arm -- whenever he wasn't pitching is what did him in.

"I was actually trying to learn a curve," Coney-Tyler said. "But I was taught to turn my wrist over -- more of a slider. All that twisting was hard on my elbow. And I was throwing every game. I think my arm just got tired."

Father, son and doctor are not alone in their shared belief that fatigue and throwing a breaking pitch were the sources of Matt's arm pain, and a large part of his pitching only four games over the following two years.

According to a study by the American Sports Medicine Institute, 47 percent of youth pitchers suffer elbow, upper arm or shoulder pain. The data suggest that these young athletes either are throwing too many pitches, or they are throwing pitches that they shouldn't be throwing at their particular stage of physical development -- namely curves or sliders.

"These pitchers are at the formative stages of their careers, both from a physical and athletic standpoint," Oakland A's team orthopedist Dr. Jerrald Goldman said. "Parents and coaches need to be aware of how many innings pitchers are throwing, how many overall pitches are being thrown, and what pitches they are throwing."

According to Goldman, throwing too much too soon can lead to injuries in the shoulder, upper arm and most often the elbow -- particularly if the player is in the midst of a growth spurt.

And, with the youth baseball postseason in full swing, this is the time of year when young pitchers are most likely to begin feeling the effects of a full season of work. Those pitchers, possibly looking for an extra edge against some tougher competition, could be tempted to try something new -- and potentially dangerous.

The fatigue factor increases with each pitch as the summer wears on, further increasing the likelihood of a breakdown in mechanics and a subsequent injury, Goldman said.

It may be hard to believe, but Coney-Tyler was one of the fortunate ones. His injury, though painful, was relatively minor, and his father was savvy enough to realize that pushing him any further at age 12 could have long-term ramifications.

San Ramon, Calif.'s, Erik Johnson, a former utility infielder for the San Francisco Giants, had a similar experience. Johnson pitched on the 1978 San Ramon team that went to the Little League World Series in Williamsport, Pa. Johnson, then 12, threw so many pitches -- many of them sliders -- in the Series that it put his career as a pitcher on hold for almost three years.

"I threw 144 pitches in 5 1/3 innings, a lot of them hard sliders," Johnson said. "I was throwing (the slider) incorrectly, and I didn't pitch again until I was 15. I shouldn't have been throwing the breaking ball. Kids aren't strong enough to throw that pitch. You need professional instruction to throw that pitch."

But Johnson, too, was lucky.

"The best thing that ever happened was that we let my arm rest," Johnson said. "Something wasn't right, and we shut it down. I have no arm troubles now. It healed, but it took awhile."

Now the director of baseball instruction for EJ Sports in San Ramon, Johnson teaches the fundamentals of pitching to Little League-age pitchers.

"The best pitch in baseball is a fastball spotted on the plate," Johnson said. "I think it's totally unnecessary for kids to throw breaking balls. I don't support it at all. I don't want any of my kids throwing breaking balls."

Others have not been as lucky as Coney-Tyler and Johnson.

"There is a condition actually called 'Little League Elbow,'" Goldman said. "But Little League is getting a bit of a raw deal, because it has done a lot to prevent this sort of injury."

Goldman added that Little League has been an active participant in studies regarding arm injuries and how to prevent them.

Little League has established guidelines in an effort to protect young pitchers.

According to Bill Schaeffer, the assistant administrator for District 4, which encompasses most leagues in Contra Costa and Alameda counties in California, no one ages 8 to 10 can pitch more than three innings in a game, and no more than six innings per week. For 11- to 12-year-olds, no pitcher may throw more than six innings per week. In tournament play at all levels, no pitcher may throw in consecutive games if he throws more than one inning the previous game.

"We haven't really looked at pitch counts because that's hard to keep track of," Schaeffer said. "A lot of managers keep track of pitch counts just (to protect the pitcher). We don't recommend throwing curveballs until a player is 14, but some parents and coaches want to win so bad that they teach their kids to throw curveballs."

One of the problems, Schaeffer said, is that some parents don't understand the dynamics of a growing body and the wear and tear pitching provides.

"I've heard of instances where a child doesn't do well in the game, then dad takes him home to throw 50 pitches in the back yard to tune him up," Schaeffer said. "Sometimes it's not what the child does when they're involved in a Little League game or practice but what happens when they go home.

"Sometimes a kid ends up with an arm injury, not necessarily from throwing curveballs but from throwing too many pitches."

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There's a significant difference between a 12-year-old elbow and, say, an 18- or even a 9- or 10-year-old elbow. According to Goldman, a large part of the problem that 11- and 12-year-olds run into is that, in the middle of a growth spurt, muscle develops at a rapid rate while bone development lags behind.

"The secondary ossification centers -- the growth plates or physeal plates -- don't fuse to the long bones until an individual is mature -- 16 or 17 years old," Goldman said. "And, since this is where the muscle and tendon joins the bone, it becomes the most inflamed in 11- and 12-year-olds."

Because of the twisting motion in the successful delivery of a slider or a curve, there is an extraordinary amount of strain placed on the medial side of the elbow (the inside part of the elbow, palm up) when a pitcher follows through, Goldman said. That's right where the bone is weakest during such a growth spurt.

This strain causes the muscle and tendon to pull severely at the junction with the bone, and often leads to injury. In severe cases, the muscle is so much stronger than the growing bone that it can pull off pieces of the bone.

"The problem is the way the pitch finishes," Goldman said. "There is a great deal of stress put on the side of the joint, and the joint is not built to handle the stress."

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Dr. Alvin Loosli, a physician at the Center for Sports Medicine in Walnut Creek, sees plenty of pitchers with sore arms. He attributes many of their problems to a fundamental lack of preparation.

"It's not about pitch count or curveballs, necessarily," he said. "It's about conditioning -- getting the arm ready to do the work.

"If the season starts in March, kids should start throwing around Thanksgiving, maybe two times a week. By Christmas, they should be getting in 100 throws three times a week."

"If the only focus is on curveballs or pitch counts, you're missing the whole thing about preseason conditioning," he said. "My criteria for throwing a curve are if a player is strong and has done a couple of months of throwing. Then, maybe you can start throwing 10 curves a week."

Loosli also is highly concerned by the tendency of some athletes to try to preempt pain by using pain relievers before pitching.

"Racehorses were the first athletes to be drug tested, because it was common to give them pain medication before they ran," Loosli said. "What happens to a racehorse with a sore foot if you keep sending it around the track? You end up sending him to the glue factory.

"It's very common for some well-meaning adult to give a kid Advil before he pitches, and that does more harm than good. We need to treat these young baseball and softball players like racehorses. Pills only after -- never before -- practice or play. That's the way you get worse -- period."

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Another study of youth pitching injuries published in Medicine & Science in Sports & Exercise followed 300 pitchers ages 9 to 12 for two consecutive years and recorded their complaints of arm pain.

Players who threw 75 or more pitches per game were 50 percent more likely to suffer elbow pain than those throwing fewer than 25 pitches. Every increment of 10 pitches per game increased the likelihood of elbow pain by 6 percent. Shoulder pain occurred in one-third of the games played. Elbow pain occurred in one-quarter of the games.

Goldman said that shoulder pain also is indicative of too much strain being placed on a growing bone.

"A lot of time is actually being spent on this," Goldman said. "But it's really a common-sense thing. If a kid is tired, don't have him pitch. If it hurts when you throw, don't throw.

"Mostly, it's about not doing the stupid thing."

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Some keys to avoiding injury, according to Goldman, Loosli and the USA Baseball Medical and Safety Advisory Committee, are:

-- Encouraging strength training in pitchers of all ages before and during the season, as well as regularly throwing away from the mound.

-- Implementing a mandatory rest period after each outing that corresponds to the number of pitches thrown. Based on feedback from the individual, these rest periods should be lengthened if fatigue or pain becomes an issue.

-- Teaching proper technique for each pitch.

-- Allowing young pitchers to begin throwing fastballs at age 8, changeups at 10 and curveballs or sliders at 14, but not sooner.

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"The first thing is, once a pitcher is hurt, they can't touch a baseball again until they don't hurt," Goldman said. "After that, you need to make sure that the pitcher is using the proper mechanics in the throwing motion, and make sure that the muscles are strong enough to handle the load."

While it is not common, Goldman said surgery can become necessary in the most severe cases.

For the most part, strength conditioning, good mechanics, rest, ice, the occasional ibuprofen tablet -- after throwing, of course -- and good old-fashioned common sense are the antidote for what ails young pitchers.

Just ask Matt Coney-Tyler, who has fully recovered from his injury, and is throwing -- yes, even the occasional curveball -- with no pain.

"It was definitely a good experience for me," Coney-Tyler said. "I learned what not to do. And I learned some other things. I lift weights now to make my arm stronger, ice, use good mechanics and throw a lot of fastballs."